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Prediabetes Is Just the Beginning

May 5, 2018
 

Diagnosis can be the first symptom of chronic diseases regardless of obesity.

Glucose levels over 125 but not over 199, one is  diagnosed with prediabetes. It can be the beginning of the complications of diabetes, such as neuropathy, nephropathy and retinopathy, but there is also the risk of other health problems. The excess glucose in one’s system tears down the immune system and increases your risk for every disease known to man.

Estimates indicate that 86 million people in the United States fit the clinical definition of prediabetes, which contributes to the epidemic of nearly 2 million new diagnoses of type 2 diabetes each year. Effort has focused on preventing or delaying prediabetes from progressing to clinical diabetes.

Of the estimated 86 million individuals with prediabetes in the United States, only 8% to 11.6%, or between 7 and 10 million individuals, have received a diagnosis and are aware of their prediabetes condition.  consistent set of chronic diseases associated with diabetes is seen in people with diagnosed prediabetes, even at lower BMI. This may indicate a greater need for more rigorous diagnosis of prediabetes. It also raises the question of whether current treatments and interventions for prediabetes, although successful in delaying progression to diabetes, sufficiently address other chronic diseases concomitant with prediabetes. Many of the chronic health conditions included in this study are closely related to obesity, and are most prevalent among populations with obesity who have diabetes. However, the increasing frequency of these conditions among people with diagnosed prediabetes at lower BMI (normal and overweight) may signify a trend of increased risk of comorbidities at lower BMI in prediabetes.

In this extensive meta-analysis of 16 prospective cohort studies that included more than 890,000 participants, Y. Huang et al found that people with prediabetes at baseline had a significantly increased risk of cancer. Additional literature has associated increased risk for kidney disease, CVD, and arthritis] with prediabetes. Risk factors for diabetes and prediabetes (age, obesity, and physical inactivity) have been documented and are confirmed in this study, with age and BMI being most highly predictive for both conditions. Conversely, regular annual checkups and access to had a protective effect on diabetes. Accordingly, the focus has been on changing lifestyle habits among people with prediabetes and diabetes and using medication.

Several international trials have demonstrated the reversion from prediabetes levels to normoglycemia, based on lifestyle and drug-based interventions. However, there are concerns that treating prediabetes with medication is an overtreatment of a nondisease condition and should be approached only in cases with other comorbidities, such as heart disease. One of the many debates about treatments of prediabetes is the question of whether the focus should be on reversing the condition or simply delaying development of diabetes. Studies suggest that prolonged duration of prediabetes can result in both microvascular and macrovascular complications of diabetes, even in the absence of overt development of diabetes. The results concur with such concerns and add to the body of knowledge addressing the possible public health implications of an extended long-term prediabetes condition.

This study highlights that many chronic disease conditions are present at high rates in prediabetes and that a prolonged period of prediabetes does not necessarily reduce the risk of certain comorbidities compared with diabetes. The results suggest that there may even be an increased risk at lower BMI among people with prediabetes to present with other chronic comorbid health conditions. In light of potential comorbidities that may occur in this at-risk population, substantial effort should be considered to identify prediabetes at a lower BMI and younger age, where rigorous attempts to reverse prediabetes to normoglycemia could prove far more beneficial in promoting public health.

We are beginning to realize that prediabetes is truly a disease that needs to be treated and even though this study had limitations, such as using self-reported data, which were not confirmed by medical records or other health history information. Self-reported data may not reflect the continuum of disease and may better be assessed with a simple functional health assessment, which was outside the limits of this study.  Although limitations are inherent in the depth and accuracy of any self-reported survey data, it nonetheless allows us to identify consistencies in variables common in both diabetes and prediabetes.

The nature of the cross-sectional survey prevents any extrapolation of causal relationships between the various health conditions used in this study and diabetes or prediabetes. Therefore, it cannot be determined if impaired glucose metabolism is responsible for other health conditions or perhaps caused by some combination of comorbidities included in this study. However, it is generally accepted that obesity is a common cause for most chronic health conditions. Furthermore, the self-reported diagnosis of prediabetes is likely an underestimation of actual prediabetes in the United States, because the American Diabetes Association only recommends screening for this condition starting at age 45, and then only if there are other health factors; similarly, adults younger than 50 may not be aware that they have diabetes.

Practice Pearls:

  • Prevalence of prediabetes is mostly underestimated as the American Diabetes Association only recommends screening starting at the age of 45.
  • Elevated blood sugars even without obesity can increase the risk of other chronic diseases.
  • Prediabetes is truly a disease that needs to be treated.

Reference:

Prev Chronic Dis. 2018;15(3):e36 © 2018 Centers for Disease Control and Prevention (CDC)